Provider Demographics
NPI:1316939853
Name:MALTMAN, CRAIG JAMES (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:JAMES
Last Name:MALTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 N. OAK AVENUE
Mailing Address - Street 2:SUITE D
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501
Mailing Address - Country:US
Mailing Address - Phone:931-783-5857
Mailing Address - Fax:931-526-6760
Practice Address - Street 1:652 N. CEDAR AVENUE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501
Practice Address - Country:US
Practice Address - Phone:931-520-0116
Practice Address - Fax:931-526-1865
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2009-12-15
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
TNMD026814207Q00000X
TNM.D.26814207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3096235Medicaid
TN1509091Medicaid
TN3096235Medicaid
TNG20363Medicare UPIN